Laparotomy Case Study

40% of homicides and 14% of suicides by firearm involved injuries to the torso. Managing these high-energy transfer wounds can be tricky because they can involve an unpredictable pattern of injuries. The most commonly injured organs are small bowel (50%), colon (40%), liver (30%), and abdominal vascular structures (25%). Immediate surgical exploration is warranted if evidence of significant vascular trauma is present. For example, abdominal distention in an unresponsive patient may indicate active internal bleeding. Other urgent signs include hypotension, tachycardia, and high or low respiratory rate. However, laparotomy is not always the standard of care in abdominal gunshot wounds. Damage control, defined as initial control of hemorrhage and contamination followed by intraperitoneal packing and rapid closure, is a promising approach for increased survival in exsanguinating patients with major vascular and multiple visceral penetrating abdominal injuries.
In addition, researchers who studied the records of GSW patients admitted during an 8-year period in a busy academic level 1 trauma center found that patients managed without surgery had significantly shorter hospital stays and lower hospital charges. Of the 792 selected for non-operative management, 80 patients developed symptoms and required a delayed laparotomy. Five patients suffered complications potentially related to this delay in laparotomy. Thus, seven hundred twelve patients were successfully managed without an operation. These patients were hemodynamically stable, without peritonitis, and without a clear transabdominal trajectory to the wound. Still, utmost caution must be taken in selecting non-operative management, because up to 20% of those with intraperitoneal trauma could have unimpressive physical signs on